ADHD and Sleep in Kids: Unraveling the Connections

Whenever I see a patient with snoring and school difficulties, I get excited. Why? Because I know that if I can diagnosis obstructive sleep apnea or another sleep disorder and treat it, I can make that child’s life better by improving their school performance, mood, and energy level. Many of these children have actually been diagnosed with attention deficit hyperactivity disorder (ADHD), or the disorder is suspected. So what are the connections between ADHD and sleep problems? NB: Many of the links below link to specific research which may be too technical so feel free to skip the links.

Many children are given a diagnosis of A.D.H.D., researchers say, when in fact they have another problem: a sleep disorder, like sleep apnea. The confusion may account for a significant number of A.D.H.D. cases in children, and the drugs used to treat them may only be exacerbating the problem.

ADHD is characterized by impulsivity, hyperactivity, and inattention. This disorder has

Sleep disorders associated with fragmented sleep or short sleep can mimic ADHD by causing inattention and behavioral difficulties. If children with these symptoms are prescribed stimulant medications such as Adderall or Ritalin, they can develop insomnia which will worsen the problem. Treatment of the underlying sleep disorder may “cure” the ADHD, or make it much easier to manage.

So what are you supposed to do?

Obviously, not every child with school difficulties or ADHD requires an overnight sleep test, or evaluation by a sleep medicine specialist. However, sleep quality and quantity should be discussed with your child’s pediatrician. Here are some recommendations.

Difficulty falling asleep or waking up at night may be associated with restless leg syndrome. The child should be asked about leg discomfort at night, frequently described as a “creepy crawly sensation” or feeling like there is “too much energy in my legs.”

Ensuring these children get enough sleep is especially important.

Evaluation by a sleep specialist may be helpful

To me, I think that aggressively improving a child’s sleep clearly pays dividends in school performance, behavior, and self esteem. Some children may no longer have ADHD after their sleep disorder is addressed. Other will still have ADHD but will have much less difficult managing their symptoms.

I’m curious to know: do any parents out there have experience with sleep problems in a child with ADHD? Any physicians who have struggled to address these issues in their patients?

Here are some other links:

For MDs and interested parents, there is a good scientific review here.

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10 Comments

Yikes, lost my earlier post!
As your friend and colleague in I know we’ve discussed this one… I love when a sleep study means not giving a kid meds for ADHD, but in my world that scenario is the exception more than the rule. Maybe that’s because I’m a neurologist (albeit one who really hates meds unless absolutely necessary), and I wouldn’t say it’s not valid to pursue a sleep study– just that, from my vantage point, behavioral treatments really need to be solidly implemented first, when there’s not a structural issue present.

Sarah– so great to get your feedback here. Some of this may be a function of our different referral populations. I have definitely seen kids with resolution of their attentional issues– they have had pretty severe sleep disorders. I would say that it is especially important that meticulous attention is paid to sleep quality and quantity for children with any learning or behavioral difficulties, as these children may be more vulnerable to the effects of limited or disrupted sleep. Also, it’s worth looking for problems like RLS.

When parents come in with the ‘teacher suggested I have him tested for ADHD’ line, I know we have a lot of ground to cover. We almost always find something significant in terms of stressors in the home environment, daily routine, poor sleep or use of TV and media into the night. I know it’s a wastebasket term but I really think the cause is ‘multifactorial.’
I think Family Therapy is often important for dealing with issues outside the child’s control.
I personally think sleep, media overusage, stress, and lack of outdoor play are big contributors. I find it really encouraging to read your article, the comments, and to know that we are trying to explore all the avenues of treatment, not just pharmacotherapy.

Thanks, Matthew. I think that the best issues are the hardest to optimize– getting enough sleep, avoiding excessive screen time, diet and exercise. Many kids will benefit so much from these interventions.

i skimmed through that article last week and found it great to hear a professional’s thoughts on it. i work with a fair number of kiddos with ADHD and a lot of them, upon diagnosis, get prescribed ritalin almost immediately. i was also reminded of this article a few months back “children’s ADD drugs don’t work long term” (http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html). it’s hopeful to know that *some* kids with ADHD actually have sleep disorders and possibly not ADHD, and therefore respond to sleep training. hopefully in future, more time will be spent correctly diagnosing these kids, resulting in a decrease in using ritalin as the first line of treatment.

Thanks. I saw the NYT article as well and thought it was really interesting. In terms of the sleep piece, if you drew a Venn diagram of the kids with sleep disorders, ADHD, there would be a significant amount of overlap. The more I practice clinical medicine, the more I see the importance of diet, exercise, and sleep in treating a whole host of disorders.

Thank you for sharing this article. Gotta show this to good friend. Her son has ADHD and is always up at night, well not all the time but most of the time. Even when the bedroom is suitable for sleeping (dark, quiet) the child is still having a hard time sleeping. If everyone else is asleep, he will just talk and talk to himself.